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help, I'm really worried...dehydration?

Hello! My daughter was born on Friday evening...so she is in her 4th day of life now. She has not had a wet or poopy diaper since last night! A friend who is an ex-LLL leader came to the house yesterday and today and said that she was latched on and swallowing nicely...but I'm really worried about her "output"! We have pumped a fair amount (like 5-7ml) of colostrum twice now and fed it to her with the syringe and tube to my nipple...and she still hasn't peed...

What do I do? Is she OK? Or is it really true that this is a stead fast rule and can't be broken?

Re: help, I'm really worried...dehydration?

Yes, it is definitely concerning if a newborn goes 24 hours without any diaper output. Normally, the diaper output will increase every day for the first 4-5 days of life, and will settle in at a minimum of 6-8 good wets and 2-3 dirties in every 24-hour period once the mother's milk has "come in."

Any output since your post an hour and a half ago?

How often has your daughter nursed in the past 24 hours? How is she behaving overall? Is she waking on her own to eat, or do you have to work to rouse her? When she is at the breast, about how long does she nurse actively before falling asleep or coming off the breast? How many wets and dirties did she make during the 24 hours Sunday evening to Monday evening (when she stopped making diapers)?

You are 4 full days postpartum now; has your milk begun to change to mature milk and increase in quantity, or are you still producing the thick sticky milk that is colostrum? What kind of birth did you have (vaginal or cesarean)?

Sometimes a baby can appear to be latched well and even swallowing but in fact is transferring very little milk. I suspect this is the most likely scenario for you, because if milk was going in, the diapers would be happening.

Rule #1 is always "Feed the baby!" Every two hours AT LEAST (more is better), try to get her to the breast and try to get some expressed breastmilk into her. Keeping your daughter in a diaper snuggled skin-to-skin against your bare chest may help stimulate her to nurse more often and more effectively. Walk her and nurse her just as much as you can for the next several hours, and offer the EBM through the syringe as frequently as possible.

If her diaper output doesn't increase very soon, it may be necessary to offer supplemental feeds of formula to keep her hydrated and growing. If this proves necessary, try to believe that it will be a temporary measure while you and your daughter work out the getting-started kinks in your breastfeeding relationship. We'll help you.

As soon as possible (and if you are in the U.S., this may not be possible until after the holiday tomorrow), get in touch with an IBCLC for an in-person consultation. In the meantime, if you are concerned at any time about your daughter's health, call her healthcare provider and explain the situation.

I will watch for your updates; hang in there and keep us posted when you have the chance.

Re: help, I'm really worried...dehydration?

Re: help, I'm really worried...dehydration?

Thank you so much for responding. I am so sorry that it took so long to update. it has been a busy and harry night.

I called the local LLL on-call person and told them about the situation. She advised pumping every half hour or so when I"m awake (after trying each time to nurse a bit first)...and then getting that colostrum into her any way possible (and the least stressful way - we have settled on using the syringe just right into her mouth like a little birdie). She has had one REALLY wet and one REALLY poppy diaper (this seemeid to be a mix of yellow poop and miconium) and one diaper that had a tiny bit of poop in it) since I posted last night.

My milk has most certainly NOT come in yet...It's still all colostrum! This is what is so hard for me...and yes, I did have a VERY long and arduous birth...I broke my water on Monday morning and then didn't have her until friday night...wound up with pitocin and an epidural (not in the plan...but so happy to have avoided the c-section).

SO - since I posted last she has not gone more than 1.5 hours without breastfeeding (in waking hours...2 hours at night) without breastfeeding. She has had 3 LONG nursing sessions (more than 15 minutes)...but mostly short little stints of a few minutes here and there. I have been pumping out the colostrum between once and twice and hour, and since 8 am today she has had 23 MLs of pumped colostrum.

The local on-call person suggested that I try this method before resorting to suplementing...do you agree, or do you think I'm doing her damage by doing it this way?

Thank you so much for your help...you all bring tears to my eyes with your support!!!

Re: help, I'm really worried...dehydration?

Hi ice_queen -- I'm so glad to see your update and to read that your daughter has had a few diapers since your first post. It is especially good news that the poop color indicates that the meconium is getting cleared out -- that's a good sign. Hopefully as the extra food she's been getting through the syringe moves through her system, you'll start to see more frequent diapers tonight. About the "tiny poop" diaper -- it counts as a dirty diaper if the poop measures about an inch across (about the diameter of a US quarter.) A faint skid mark doesn't count, but it really doesn't take a big poop to measure an inch in size.

You should be so proud of yourself for being so dedicated and putting so much effort into breastfeeding, especially after such a difficult birth. You must be beyond exhausted. I hope you have lots of good help at home right now.

I am especially impressed by your willingness to reach out for knowledgeable help early on. It sounds like you had great support by phone last night with the local LLL Leader. I will again urge you, at the earliest opportunity, to meet with a IBCLC who can evaluate what exactly is going on when your daughter nurses. The diaper count seems still to be a bit low today, even with the frequent supplemental feeds of colostrum. The question to sort out with an IBCLC is whether that is because of a lack of milk on your part or an ineffective suck or other problem on your daughter's part.

The frequent pumping and nursing will help your milk to come in -- keep that up. Your question naturally is whether to continue offering only pumped colostrum or to supplement with formula as well. Unfortunately, that's not something I can determine based on a few posts on a messageboard. I will share some more information with you that will hopefully help you to discern whether the benefits of formula supplementation (extra fluid and calories) would offset its risks (disrupting your daughter's "virgin gut," perhaps impacting your milk supply, etc.)

Aside from low diaper output, some other signs of dehydration include lethargy, dry mouth, or a sunken soft spot. It can be tricky to distinguish normal newborn sleepiness from abnormal lethargy. This is why I asked questions in my first post about her overall behavior, whether she wakes on her own, how hard it is to rouse her, etc.

Another useful test is to gently pinch together a fold of skin on the back of your daughter's hand. If it springs right back, that's a good sign. If it stays a bit "tented" in shape, that's a sign of dehydration.

Here is a story from a LLL magazine that explains more fully how to identify dehydration in a breastfed infant. Again, I will underscore that LLL Leaders aren't medical professionals; if you have any doubts that your daughter is okay, you should contact her healthcare provider. A weight check at the doctor's office or clinic tomorrow morning might help you get a clearer picture of the situation as well.

If this situation (low diaper count, milk still not plentiful) continues much longer, then supplemental feeds of some sort will certainly be necessary. You might begin now to explore whether donor breastmilk would be available to you in that situation. This would be an excellent question for a local IBCLC as well as your daughter's healthcare provider.

Good luck, and please do keep us posted as your time and energy allow. If anything I've written is unclear or creates another question for you, don't hesitate to post for a clarification or more information.

Re: help, I'm really worried...dehydration?

Thank you again...
What is a IBCLC? I am ready to find one just as soon as I know what one is.

She has no sunken soft spot and her skin does not seem to "tent" when pinched.

It is hard for me to say whether she is lethargic or not...I do have to wake her for most feeds (especially during the day...she is much more alert in the evenings/nights). She does have several times of alterness during the day when she just looks around at everything and everyone seeming to really be watching it But, most of the time she sleeps...i can't tell (being my only child) if she is sleeping an unusual amount of the time...Last night she "nursed" for a very long time looking around the whole time...today she has had a few periods of alertness but I have had to wake her for most feeds. Most often as soon as that pumped colostrum hits her lips she wakes up...but sometimes it takes tickling her feet or whatnot to get her to awake.

I will call my pediatrician tomorrow morning...I am just so scared that I have done something to harm her already...i had no idea that a prolonged labor can cause milk to be late...no one told me...and I just wasn't ready for that to be a possibility. I feel bad that we just started pumping last night...but I know I can't dwell on that...especially not now!

So, how many wet diapers does a baby have in a day if they are only getting colostrum still? Can't be as many as if they are getting full-on breast milk right?

Re: help, I'm really worried...dehydration?

Originally Posted by ice_queen

I called the local LLL on-call person and told them about the situation. She advised pumping every half hour or so when I"m awake (after trying each time to nurse a bit first)...and then getting that colostrum into her any way possible (and the least stressful way - we have settled on using the syringe just right into her mouth like a little birdie). She has had one REALLY wet and one REALLY poppy diaper (this seemeid to be a mix of yellow poop and miconium) and one diaper that had a tiny bit of poop in it) since I posted last night.

That's wonderful! Yay for poop!

She is four days old today, yes? You should expect to see at LEAST 4 pees and 2 poops. It's good that the poop is turning yellow! That means that meconium is moving on out. Here's some info and pictures:http://www.lactnews.com/the_diaper_images.html

Pumping is GREAT for increasing output, but nursing is even better. Nurse as often as you can. If your baby LOOKS at you, nurse! Seriously. Make it a priority to to bed with baby and do nothing but eat, sleep, go to the bathroom and nurse. Be sure she is latched on well!

Have LOTS of skin to skin contact. This is GREAT for your baby's coordination AND your hormone levels. Skin to skin contact can actually increase your milk production! Strip baby down to a diaper. Take off your top. Hold baby upright on your chest. Cover both of you with a blanket (or wrap a robe around both of you) to stay warm. After a while, your baby may begin to "peck" her way down your chest. You will find that you will nurse more frequently and your baby will spend more time in the quiet alert state.

My milk has most certainly NOT come in yet...It's still all colostrum! This is what is so hard for me...and yes, I did have a VERY long and arduous birth...I broke my water on Monday morning and then didn't have her until friday night...wound up with pitocin and an epidural (not in the plan...but so happy to have avoided the c-section).

SO - since I posted last she has not gone more than 1.5 hours without breastfeeding (in waking hours...2 hours at night) without breastfeeding. She has had 3 LONG nursing sessions (more than 15 minutes)...but mostly short little stints of a few minutes here and there. I have been pumping out the colostrum between once and twice and hour, and since 8 am today she has had 23 MLs of pumped colostrum.

It is GREAT that she is nursing frequently. Does she latch on well once she gets there? Can you hear swallowing?

Originally Posted by ice_queen

The local on-call person suggested that I try this method before resorting to suplementing...do you agree, or do you think I'm doing her damage by doing it this way?

You ARE supplementing with your own milk, and that is the optimal way to supplement. As long as she is having enough pees and poops, no worries!

Originally Posted by ice_queen

What is a IBCLC? I am ready to find one just as soon as I know what one is.

She has no sunken soft spot and her skin does not seem to "tent" when pinched.

Wonderful!

Originally Posted by ice_queen

It is hard for me to say whether she is lethargic or not...I do have to wake her for most feeds (especially during the day...she is much more alert in the evenings/nights). She does have several times of alterness during the day when she just looks around at everything and everyone seeming to really be watching it But, most of the time she sleeps...i can't tell (being my only child) if she is sleeping an unusual amount of the time...Last night she "nursed" for a very long time looking around the whole time...today she has had a few periods of alertness but I have had to wake her for most feeds. Most often as soon as that pumped colostrum hits her lips she wakes up...but sometimes it takes tickling her feet or whatnot to get her to awake.

I will call my pediatrician tomorrow morning...I am just so scared that I have done something to harm her already...i had no idea that a prolonged labor can cause milk to be late...no one told me...and I just wasn't ready for that to be a possibility. I feel bad that we just started pumping last night...but I know I can't dwell on that...especially not now!

You're doing GREAT!

Originally Posted by ice_queen

So, how many wet diapers does a baby have in a day if they are only getting colostrum still? Can't be as many as if they are getting full-on breast milk right?

She's four days old, so at least four. Keep nursing (don't forget breast compressions!) and giving her extra from a syringe or spoon.

Originally Posted by ice_queen

This is so hard...thanks again.

Oh, mama! We've all been there. It IS hard. But, you know what? You will get through this! You will be fine, and your baby will be fine. Remember that breastfeeding is an art, not a science. You and your baby have to learn this "dance" together.

Re: help, I'm really worried...dehydration?

Originally Posted by ice_queen

What is a IBCLC? I am ready to find one just as soon as I know what one is.

Thanks to home exec above for posting the link to ILCA. An IBCLC is an International Board Certified Lactation Consultant. That's the credential to look for when dealing with an unusual or especially serious/complicated breastfeeding problem. Not all IBCLCs belong to their professional association (ILCA), and so there may be local IBCLCs who are not listed on the ILCA website. Just use it as a starting point, and also ask your healthcare providers or inquire at area hospitals.

She has no sunken soft spot and her skin does not seem to "tent" when pinched.

That's a good sign!

It is hard for me to say whether she is lethargic or not...I do have to wake her for most feeds (especially during the day...she is much more alert in the evenings/nights). She does have several times of alterness during the day when she just looks around at everything and everyone seeming to really be watching it But, most of the time she sleeps...i can't tell (being my only child) if she is sleeping an unusual amount of the time...Last night she "nursed" for a very long time looking around the whole time...today she has had a few periods of alertness but I have had to wake her for most feeds. Most often as soon as that pumped colostrum hits her lips she wakes up...but sometimes it takes tickling her feet or whatnot to get her to awake.

Many newborns are sleepy; your description sounds like normal newborn sleepiness, not dangerous lethargy. She responds to the stimuli of foot tickling and sweet tastes (the colostrum), and she is having daily quiet-alert periods -- these are all excellent signs that she is doing okay.

I will call my pediatrician tomorrow morning...I am just so scared that I have done something to harm her already...

Based on the positive signs in your last couple posts, I think it is very, very unlikely that your daughter has suffered any serious harm. Do call the ped tomorrow to put your mind at ease. You might consider taking your baby in for a quick weight check, to be used as just one of several indicators of how she is doing.

i had no idea that a prolonged labor can cause milk to be late...no one told me...and I just wasn't ready for that to be a possibility.

You are actually still within the range of normal for milk coming in after a vaginal birth. If your daughter's diaper output had been normal throughout these first days, no one would be terribly concerned about the fact that you are still making colostrum instead of mature milk.

As the next week or so unfolds, if your milk supply turns out to be a cause for concern, it probably will not be due to the length of your labor. There are several factors related to events at birth that, if they go wrong, may cause milk supply problems. You don't need to worry about that right now -- we can help you "play detective" if there is a problem later. My hunch is that the problem is on your baby's end, perhaps related to her suck or her ability to transfer milk from breast to tummy. This is something that expert, in-person help from an IBCLC can help to identify and correct.

I feel bad that we just started pumping last night...but I know I can't dwell on that...especially not now!

Well, you didn't know there was a problem until her diapers stopped happening. You actually have been reacting very quickly to the situation and have done extremely well to seek out reliable information and expert help promptly. You are still very newly postpartum -- if all other conditions are conducive to it, your milk supply should not suffer long-term from just a couple days' reduced stimulation.

So, how many wet diapers does a baby have in a day if they are only getting colostrum still? Can't be as many as if they are getting full-on breast milk right?

That's hard to say, because it all depends on how much colostrum is getting into the tummy. It's impossible to measure that, and so we look to diaper output, which normally will gradually increase with each day of life. When diapers stop happening altogether for 24 hours, then the issue is not as simple as colostrum being slow to change to mature milk -- there is probably something awry with the transfer of milk.

These are problems that almost always have breastfeeding-friendly solutions. The critical thing is to keep the baby fed and growing, and to protect the milk supply by pumping, while you, your daughter, and your support team get things figured out.

This is so hard...thanks again.

It IS hard -- and you have had an especially rough beginning. You are doing a wonderful job caring for your new baby; she is so lucky to have you. Hang in there! It will get easier.